Aldo Fortuna

Cerebral oligodendroglioma: prognostic factors and life history.

The records of 137 patients with supratentorial oligodendroglioma treated surgically between 1953 and 1986 were reviewed. The tumors were rated histologically benign or malignant. In the 105 patients followed up with a minimum observation time of 5 years to December 1991, the mean postoperative survival was 90.2 months (standard error, 9), the median 64 months (standard error, 9.6), the 5-year survival rate 52.4%, and the 10-year survival rate 24%. Sixteen possible prognostic factors, broken down into two or more variables each, were considered in the survival study on univariate methods (5-year survival rate, survival curves, and Coxs hazard function) and on multivariate analysis according to Coxs stepwise proportional hazards model. The latter showed that variables correlated positively with survival were benign histological findings (P, 0.000), postoperative radiation therapy (P, 0.004), and time of operation from 1977 to 1986 (P, 0.044) in 105 patients of the whole series, and period of surgery from 1977 to 1986 (P, 0.000), subtotal or total surgical resection of the tumor (P, 0.001), and radiation therapy (P, 0.005) in the subgroup of 79 patients operated on for benign tumors. However, the most interesting point to emerge from the study was the relevance of admission clinical status to the survival of patients who did not receive radiation therapy and to the prognostic response of those who did. Of the 40 patients with seizures and negative neurological status--Clinical Syndrome A--the 10 who did not receive radiation therapy had survived as long as the 30 who did (5-year survival rate, 80 versus 67%; P, not significant; median survival, 122 versus 85 months; Breslow and Mantel-Cox P, not significant), whereas of the 65 patients with intracranial hypertension and/or neurological deficits--Clinical Syndrome non-A--the 18 who did not receive radiation therapy had short survival times, and the 47 who did fared significantly better (5-year survival rate, 11 versus 53%; P, 0.002; median survival, 32 versus 64 months; Breslow and Mantel-Cox P, 0.000). These findings were not significantly affected by the exclusion of malignant neoplasms and in the group of benign tumors, in which the histological characteristics have not been found to be significantly different between those with A and those with non-A clinical syndrome, did not depend on different frequencies of subtotal or total tumor removal.(ABSTRACT TRUNCATED AT 400 WORDS)

Arachnoid diverticula: A unitary approach to spinal cysts communicating with the subarachnoid space

SummaryThe authors report six cases of so-called spinal subdural arachnoid cysts, emphasizing the clinical and myelographic findings which, if not properly evaluated, may be misleading diagnostically.The literature of so-called perineural cysts and of extradural arachnoid cysts is likewise reviewed. Their clinical, roentgenological, and pathological features are examined. A common pathogenesis for all these lesions is proposed. It implies disruption and secondary proliferation of the arachnoid membrane.Hence, the term arachnoid diverticulum is advanced to include all lesions communicating with the subarachnoid space. Their varying relations with the subarachnoid space depend on the sites of the primary abnormalities and on hydrodynamic factors. Numerous observations of associated arachnoid diverticula, either perineural, subdural, or extradural, further favour a common pathogenesis.

Intramedullary spinal cord ependymomas — a study of 45 cases with long-term follow-up

SummaryOf the 62 patients with intramedullary spinal cord ependymoma treated surgically at our Neurosurgery Division between January 1951 and December 1990 45 had a follow-up of at least 3 years and the longest 30 years. The 28 conus-cauda equina-filum ependymomas operated during the same period are not considered in this study. An analysis of our cases and of the larger published series shows that favourable prognostic factors, apart of course from total tumour removal, which is now usually possible, are a site below the high cervical segments and a mild pre-operative symptom pattern. Patient age at diagnosis, tumour size and “low dose” (< 40 Gy) radiotherapy seem to have no influence on the prognosis. Aggressive surgical removal is the treatment of choice and also for long-term recurrence.

Intradural spinal cysts.

Summary18 cases of benign intradural spinal cyst (9 arachnoidal, 2 neuroepithelial, 7 endodermal) are reported and compared with 94 cases (67 arachnoidal, 7 neuroepithelial, 20 endodermal) obtained from the literature.Arachnoidal intradural cysts (AIC) have no sex preference, occur at around the fourth-fifth decades of life and have characteristic intermittent root symptoms. They prefer the thoracic level and the posterior position. (Myelography images the cystic cavity (diverticular form). Surgical removal is usually easy.Neuroepithelial intradural cysts (NIC) are rare, have a 2∶1 predilection for females and occur after the fourth decade. They have a serious clinical course similar to intramedullary or extramedullary tumours. They prefer the conuscauda and the anterolateral positions. They often give rise to manometric block and to albuminocytological dissociation. There may be substantial adhesions to the cord and roots and the intramedullary variety presents no clear plane of cleavage.Endodermal intradural cysts (EIC) have a 2∶1 predilection for males and prefer the second and third decades. They may have an intermittent or serious course with signs of root and cord impairment. They prefer the cervical segment (in the anterior position) and the conus-cauda (in the posterior position). As a rule they present manometric block and albuminocytological dissociation. Their frequent tough adhesions to the roots and cord demand special care during their removal.

Long-term results of the surgical treatment of spinal dermoid and epidermoid tumors

The clinical findings and the results of surgical treatment in 16 patients with spinal dermoid or epidermoid tumors are reported. In 9 patients the tumor capsule adhered so tightly to the nervous tissue that part of it was left in situ. In a follow-up study ranging from 5 to 30 years with a mean of 14.2 years only 1 patient had a recurrence of the tumor and 10 patients resumed a normal working life.

Intracranial arterial aneurysms in early childhood

Cerebral saccular aneurysms are rare in early childhood. Seventy-one cases in children under 5 years of age found in the literature, plus one case of our own, are analyzed. In early childhood these aneurysms seem to have features that distinguish them from the same variety in adults. In children a congenital pathogenesis appears more convincing because of the higher frequency in the first 2 years of life, the often peripheral site (41.6%), the high frequency of large (50%) or giant (26.8%) aneurysms, and the association with other cerebral and vascular congenital abnormalities. Onset was nonhemorrhagic in 18.1% of cases compared with 2.5% in adults. The surgical outcome seems better in children than in adult patients in terms of both morbidity and mortality.

Neurinoma of the third, fourth, and sixth cranial nerves: A survey and report of a new fourth nerve case

A rare case of trochlear nerve neurinoma is described. Including this case, the number of reported intracranial tumors arising from the sheaths of the third, fourth, and sixth cranial nerves is 38. By site and relationship to the nerve segment, they fall into three groups: cisternal, cisternocavernous, and cavernous. In cisternal tumors of the third and sixth nerves, paresis of the nerve hosting the tumor is the unique nerve deficit; by contrast, in those of the fourth nerve, paresis of the trochlear nerve can be absent and that of the third nerve present. In the latter tumors, a peculiar ataxic hemiparesis syndrome is produced by midbrain compression. Cisternocavernous neurinomas often cause symptoms of intracranial hypertension, while cavernous neurinomas bring about two clinical features: paresis of one or more nerves of the cavernous sinus and a clinicoradiological orbital apex syndrome. At surgery, generally cisternal neurinomas are totally removed and the nerve source of the tumor identified; in cisternocavernous and cavernous neurinomas, total removal of tumor and identification of the parent nerve have been reported in only half of the cases. In the majority of parasellar neurinomas, clinical differences can be found between those arising from the nerves governing eye movement and those arising from the gasserian ganglion.

Spinal Glioblastomas: Report of Seven Cases and Review of the Literature

Intramedullary glioblastomas are uncommon tumors. They occur chiefly in the cervicothoracic segments, have a slight tendency to occur in the early decades of life, and have a short clinical history before diagnosis. We report seven cases and discuss the salient features of these tumors, particularly the pathological features and treatment, in light of the relevant literature.

Glossopharyngeal neuralgia with cardiac syncope.

Glossopharyngeal Neuralgia is an uncommon craniofacial pain syndrome that is occasionally associated with cardiac syncope. Involvement of the glossopharyngeal nerve may be painless or may be marked by true episodic neuralgia, and this justifies the term neuralgia reported here. We present 5 cases of this uncommon syndrome, of a total of 15 observed cases of glossopharyngeal neuralgia, successfully treated by section of the rootlets of Cranial Nerves IX and X or by microvascular decompression in the posterior cranial fossa. We also analyze the relevant literature and discuss the pathogenesis and treatment of the syndrome.

Cerebral meningiomas in children.

Cerebral meningiomas are rare tumors in children that represent 1.4% of CNS tumors and 1.5% of intracranial meningiomas. We have analyzed 197 cases of cerebral meningiomas under 16: 178 cases were taken from the available literature and 19 from our series. When comparing pediatric meningiomas with those of adults, we noted some differences. Before the age of 16 there is a slight preference for males; the intraventricular variety is more frequent; cystic meningiomas and the absence of dural attachment are more frequent findings; the neuroradiological diagnosis is more difficult.